life or limb
November 30, 2011 1:46 PM   Subscribe

If you show up at an emergency room (in the US) with a limb in a tourniquet and claim that you got injected/infected/poisoned/exposed to something fatal on that limb (dimethylmercury for example, but others exist), will they amputate it on request?
posted by parallax7d to Health & Fitness (34 answers total) 4 users marked this as a favorite
 
They will want to run some tests first, malpractice suits are not a hospitals best friend.
posted by pwally at 1:49 PM on November 30, 2011 [2 favorites]


You're asking if an ER will just amputate a limb upon request, without any kind of verification on their part? Umm ... no.
posted by Cool Papa Bell at 1:50 PM on November 30, 2011 [15 favorites]


I am not a doctor, but I'm fairly certain a serious procedure like an amputation would not be performed "on request." Any serious emergency procedure is going to be performed because a doctor decides that it is necessary and the correct course of action, not because a patient asks for it.
posted by Nightman at 1:50 PM on November 30, 2011 [3 favorites]


No.
posted by FAMOUS MONSTER at 1:52 PM on November 30, 2011 [3 favorites]


If you show up at an emergency room (in the US) with a limb in a tourniquet and claim that you got injected/infected/poisoned/exposed ...

You will probably be admitted and placed under the care of a physician who will run some tests and decide on a course of treatment for you.
posted by three blind mice at 1:53 PM on November 30, 2011 [3 favorites]


Yeah, they will first want to establish you are not fucking insane.
posted by blargerz at 1:53 PM on November 30, 2011 [39 favorites]


No more likely than you showing up saying "can I have a whole lot of Oxycontin, to go?" and getting it. The doctors decide what happens, and if surgery is necessary, not you.

Read up a bit on M√ľnchausen syndrome. Last thing a hospital needs is to a) take up valuable doctor-time and b) open themselves up to expensive lawsuits.
posted by griphus at 1:53 PM on November 30, 2011 [3 favorites]


I seriously doubt that amputating a limb that had been exposed to dimethylmercury would do anything, anyway. Aggressive and immediate chelation therapy? Possibly. A tourniquet and subsequent amputation? Uh, probably not.
posted by lydhre at 1:59 PM on November 30, 2011


I think they would try to treat it however else they could- amputation would be a last resort. Then they'd probably have you talk to a psychiatrist? (more)
posted by GastrocNemesis at 2:05 PM on November 30, 2011 [2 favorites]


I can't visit Body Modification Ezine at work, but I recall an article in the BME blog a few months ago about someone with BIID who allegedly recieved a medical foot amputation by intentionally causing severe frostbite in the foot before visiting the emergency room.

Note: This is not intended to be medical, psychiatric, or body modification advice. If you are looking to induce amputation, please speak with a trusted friend and a therapist knowledgeable about BIID first.
posted by muddgirl at 2:12 PM on November 30, 2011 [1 favorite]


Um yeah, no, they totally won't.

Man, I seriously hope you're writing a book or something.
posted by ottereroticist at 2:14 PM on November 30, 2011 [24 favorites]


I'm not a doctor, but (putting aside the claims of some kind of damaging injection) surely it is theoretically possible to do enough damage to a limb simply from the Tourniquet alone to force an amputation. This would almost certainly have serious consequences both physically (I think there may be a risk of embolism or cardiac arrest) and socially (it would almost certainly lead to a psychiatric evaluation and perhaps even involuntary commitment).

Perhaps I am misunderstanding the question, and this does not involve BIID but rather some kind of fictional scenario where someone is actually involuntarily tourniquetted and injected with a substance.

Either way amputation would not occur "upon request" but rather at the medical discretion of a team of doctors.
posted by muddgirl at 2:20 PM on November 30, 2011


No they won't amputate on request. Speaking from experience here I have gone to the ER several times for an acute but recurrent condition, told them exactly what I had and what treatment works (IV fluids and antibiotics) and they still dot their i's and cross their t's even though I am not requesting anything nearly as serious as an amputation or narcotics. This is how it is and should be.
posted by boobjob at 2:40 PM on November 30, 2011 [1 favorite]


Response by poster: Makes sense that they would want to confirm the exposure, and amputate as a last resort. But say the tests take too long, or they don't have the ability to test for whatever fatal substance is involved, and have only your word?

Implausible, perhaps, but in this situation would they likely error on the side of not amputating and possibly causing death? I can understand how the chances of surviving and litigating could be high, vs. someone dying and not being able to litigate. Even if their relatives sue, the hospital could claim they were following procedures and could not confirm your claims of being poisoned.

lydhre - is this because the mercury would not be transmitted through the bloodstream?
posted by parallax7d at 2:41 PM on November 30, 2011


Response by poster: ottereroticist - no book, just curiosity. It would be interesting if this situation would be a valid case for not going to the hospital, or perhaps to illustrate hospitals not being able to address a case properly, even when one party is clearly communicating the issue in a time critical fashion.
posted by parallax7d at 2:44 PM on November 30, 2011


Mod note: Folks, for this not to be a hypothetical "what iffish" chatfilter question, it needs to be answering questions and not lulzy comments and/or an ongoing meandering discussion on related topics
posted by jessamyn (staff) at 2:48 PM on November 30, 2011


perhaps to illustrate hospitals not being able to address a case properly

Well, one could argue that they are addressing a case properly by taking the time to independently verify an unusual claim.

On the other hand, hospitals take patients at their word every day in many other mundane contexts, some of which can be deadly. Are you currently on any medication? Are you allergic to any medication? On a scale of 1-10, how would you describe the pain you're feeling now?
posted by Cool Papa Bell at 2:57 PM on November 30, 2011 [1 favorite]


Is there actually any sort of injectable substance where the patient could be saved if the injected limb is amputated, yet there is not time to perform a proper examination (as with insect bite excisions)? I don't think the circulatory system works that way.
posted by muddgirl at 3:07 PM on November 30, 2011 [8 favorites]


"Oh my gosh, oh my gosh, I've been injected with horrible death-causing agents, please help me" will be how they hear your request - they're going to ignore what you think they should do. They want to know facts: when were you injected, when did you put the tourniquet on, how do you know what the substance is. Your opinion, as a random guy off the street, is valuable only to the extent it is unavoidably necessary (and only then if that necessity is blindingly obvious.)

Also, a lot of the time even when they flat-out ask you something (like what medications you're on,) they don't entirely believe you. As a woman of childbearing age, it doesn't matter what I say at the admissions desk, they always check for pregnancy (through blood tests) before giving me drugs or exposing me to radiation, for instance. There's a bunch of rules of thumb for emergency department personnel, actually. Chest pain is cardiac arrest until proven otherwise, for instance. They're also trained to be cautious - all of my doctors consider me potentially asthmatic (it's in all my charts) because of one bad episode of bronchitis, even though I can breathe okay under exertion. As a result, I'll probably never be prescribed beta-blockers.

(It doesn't help that emergency departments see a lot of unhelpful behavior from patients. If someone is at a hospital, in pain, and perceives their situation to be a crisis, this is always going to be true, and then you realize that most inpatient psychiatric stays start in the ED, that many of the uninsured and most of the homeless get the majority of their care from emergency services...)
posted by SMPA at 3:10 PM on November 30, 2011 [3 favorites]


Yeah, I'm not sure how much discussion is really necessarily here. The answer to the question the OP asked is as follows: No.
posted by Justinian at 3:18 PM on November 30, 2011 [5 favorites]


But say the tests take too long, or they don't have the ability to test for whatever fatal substance is involved, and have only your word?

No. Where this falls down is in the patient's request for a specific treatment. "Something happened to my limb and here's what it is" would be fine, and there's no reason they wouldn't factor your word into it. The problem arises at "So amputate it, please." They have every reason to think you know what happened to you, but as they're medical professionals and you're not, they have no reason to think you know what the ideal treatment would be.

Implausible, perhaps, but in this situation would they likely error on the side of not amputating and possibly causing death?

Though the terms you're using are kind of loaded, the short answer is yes.

It would be interesting if this situation would be a valid case for not going to the hospital, or perhaps to illustrate hospitals not being able to address a case properly, even when one party is clearly communicating the issue in a time critical fashion.

The short answer is no.
posted by FAMOUS MONSTER at 3:19 PM on November 30, 2011 [2 favorites]


A vastly more-likely-to-result-in-prompt-amputation alternative (terrible, not recommended at all, don't do this, please) solution would be to, instead of doing the tourniquet thing, cutting your own arm off and then going to the hospital ER for after-care. I'm reasonably confident they won't reattach the limb, especially if you leave it behind.

I suspect you'd still die, from the poison, the blood loss, or the accident you got into on the way to the hospital as you lost control of the car due to your body dealing with the poison and the blood loss.
posted by SMPA at 3:27 PM on November 30, 2011 [2 favorites]


The ER simply isnt going to rely on your testimony alone, that would be malpractice not the failure to act. Yes if I go into the ER complaining of a rattlesnake bite and have clear puncture wounds the will start antivenin but there is no evidence in your case. Unless you tell them of a condition you have (say penicillin allergy) and they ignore you and proceed with a treatment they should know full well would kill you there is no likelihood of them loosing in a wrongful death suit.
posted by boobjob at 3:36 PM on November 30, 2011


If you show up at an emergency room (in the US) with a limb in a tourniquet and claim that you got injected/infected/poisoned/exposed to something fatal on that limb (dimethylmercury for example, they will probably take blood, skin biopsy, and ask a ton of questions to try to verify the situation. The patient might be isolated due to the extreme toxicity. If it's quite urgent, they may begin treatment, if the treatment is not drastic, as amputation would be. Chelation might be started based on possible exposure to a powerful toxin.

However, once the truth is discovered, preferably by Dr. House and his assistants, the patient would likely get a psych consult. And, if it's House, a lumbar puncture.
posted by theora55 at 3:47 PM on November 30, 2011 [3 favorites]


Let's say one were able to successfully (bad pun) pull this off, and have the limb removed. If it's anything like transplant recipients, they'll do an autopsy on the removed body part. Chances are, one would become famous pretty quickly. And, not for good reasons.
posted by SillyShepherd at 5:13 PM on November 30, 2011


An amputation is such a gravely serious procedure that there is no way, under any circumstance, a competent and ethical doctor would amputate it based on your word alone, without independently diagnosing that amputation is in fact necessary.

I think you may be underestimating the amount of crazy, off-the-wall shit and preposterous self-diagnoses that medical professionals hear.

If the choice is between doctors taking your word that your limb must be amputated and amputating it based on that alone, and you dying because the doctors insisted on diagnosing you themselves, you will die. Every time.

There's nothing that you could tell them that would lead them to amputate a limb like this.
posted by jayder at 5:36 PM on November 30, 2011 [2 favorites]


Dude, this is NOT BURGER KING.

You cannot just walk into a medical facility, wave money or an insurance card at them and order an amputated limb the way you'd order extra pickles.

Medicine doesn't work that way.
posted by jason's_planet at 6:28 PM on November 30, 2011 [6 favorites]


Based on my experience with the medical establishment, and the difficulty a friend of mine had getting an amputation, I can't think of a scenario where they would do this.
posted by rmd1023 at 6:50 PM on November 30, 2011


Amputation is a last resort. Even coming in with a complete traumatic amputation, they will try to reattach the limb unless it is missing or damaged beyond repair.

The only time an amputation is really "optional" is if the damaged limb fails to heal acceptably after more conservative methods are exhausted, or in cases of untreatable sepsis where it becomes necessary to amputate the limb in order to stop the infection from spreading to more vital organs. Sometimes you can have a damaged limb voluntarily amputated if you have severe circulation problems, wounds that don't heal, etc. and the amputation would lead to a better quality of life and options for mobility.
posted by elizeh at 7:40 PM on November 30, 2011


Amputations are surgeries, and surgeries are expensive. Absurdly expensive.

If you have health insurance, you will not be given surgery unless you are dying and/or your provider gives the all-clear. If you do not have health insurance, you will not be given surgery unless you are dying, and even then you might be out of luck.

Given that so much of this will depend on whether or not you're dying, the doctors are going to want to make damn sure that you are, in fact, dying. So there will be tests. Lots and lots of tests.

Something else to note: ER doctors interact with batshit crazy people on an hourly basis. They know how to spot them. They know how to handle them. They are not easy to deceive.
posted by dephlogisticated at 8:57 PM on November 30, 2011 [3 favorites]


In America - certainly not.

It's not quite the same thing, but as a 3rd grader in Malaysia, I had a hernia operation. During an earlier dr's appintment (the hernia wasn't an emergency, but needed to be resolved), I asked the doctor if I could have my appendix removed, since it was in the general area and wasn't any good and my cousin had a near fatal case of appendicitis earlier in the year.

He did. I don't have an appendix anymore. Given, it's a lot less useful than a limb.
posted by sawdustbear at 11:49 PM on November 30, 2011


I'm an ER doctor. I routinely see patients who have outlandish stories (or who show up unable to tell their story because they are too confused, unconscious, intoxicated) and have to decide what to do with them based on my assessment of their veracity, physical exam, and objective test result findings.

In the scenario you describe, although others have already alluded to this, I would take the tourniquet off and do a physical exam. A tourniquet, contrary to popular belief, will not keep a fatal substance you've injected from entering the rest of your body. Remember, your heart pumps 60-80 times a minute, more like 100 or more times a minute when you're excited. That blood is moving FAST. By the time you get the tourniquet on, it's too late. You're just keeping blood out of your arm and causing horrible arm pain from lack of oxygen to your tissues (think keeping a rubber band on your finger for too long).

This is a common myth related to spider and snake bites. If you look up treatment of spider and snake bites on the webs, you'll see that the sites all say "no tourniquet!"

We rarely use tourniquets in the ER (I never have), although they are used on the battlefield when people are bleeding out from an extremity injury, because losing a limb from tissue death due to a tourniquet is not as bad as dying from hemorrhage.
posted by treehorn+bunny at 11:57 PM on November 30, 2011 [7 favorites]


We rarely use tourniquets in the ER (I never have), although they are used on the battlefield when people are bleeding out from an extremity injury, because losing a limb from tissue death due to a tourniquet is not as bad as dying from hemorrhage.

Right, I am not a doctor at all, but from what I know about first aid, a tourniquet is meant to keep too much blood from getting out of the body rather than to keep toxins out of (the rest of) the body. Other than the combat example used above, I've only heard tourniquets recommended for times when someone injures themselves in a rural area, usually in the context of using heavy machinery. So if say you are using a chainsaw in the middle of the woods and end up accidentally cutting most of a limb off, a tourniquet would be a way to buy some time before you bleed out. There could be ways for a hospital to make a bad decision because they don't believe a patient, but your amputation scenario in particular is not really a situation where doing something drastic based on what the patient says would actually help at all.
posted by burnmp3s at 6:56 AM on December 1, 2011


sawdustbear: I ended up getting admitted from the ER for surprise ovary removal due to (happily slow-growing) cancerous cysts. The surgery involved a big incision down most of my abdomen. While they were in there, they removed my appendix. The rationale given was that if I ended up getting appendicitis later in life and could not accurately report my condition, it was highly likely that someone would look at the scar and assume I'd had my appendix out and thus not treat it as quickly as one might hope.
posted by rmd1023 at 8:15 AM on December 1, 2011 [1 favorite]


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